Your Digest for Wednesday, Mar 27, 2024 05:59 PM


[!INFO] Löfgren’s syndrome:
Lofgren's syndrome is an acute form of the disease characterised by:


Sarcoidosis

[!TIP] Summary
Symmetrical Bilateral Hilar lymphadenopathy (BHL) is a characteristic feature of sarcoidosis and is usually asymptomatic.

Sarcoidosis.png
#sarcoidosis

[!INFO] Lupus pernio
LupusPernioSarcoidosi.png

Lupus pernio = cutaneous sarcoidosis
Lupus vulgaris = cutaneous tuberculosis

Heart can also be involved: Mild to life threatening spectrum.

Clinical features:

SarcoidosisStages.png

[!INFO] Löfgren’s syndrome:
Lofgren's syndrome is an acute form of the sarcoidosis characterised by

[!INFO] Heerfordt's syndrome
Heerfordt's syndrome
A rare subacute form of [[Sarcoidosis]]
HeerfordtsSyndrome.webp (uveoparotid fever) there is parotid enlargement, fever and uveitis secondary to sarcoidosis

Investigations

FBC: Leukopenia and eosinophilia + thrombocytopenia (rare) and Mild NCNC anaemia.
CXR: Bilateral Hilar lymphadenopahty - very common!
Hypercalcemia secondary to increased vitamin D production (macrophages activate a vitamin D precursor)
Renal involvement with elevated creatinine is uncommon

Prognosis

Management

Causes of bilateral hilar lymphadenopathy

[!TIP] Bilateral Hilar lymphadenopathy SCaLP
Causes of bilateral Hilar lymphadenopathy

  1. Lymphoma,
  2. pulmonary TB,
  3. carcinoma of the bronchus,
  4. sarcoidosis
    #hilar-Lymphadenopathy #mediastinal-Lymphadenopathy

Differential diagnosis of hilar lymphadenopathy

Clinical context: "non superficial lymph nodes".
(In contrast, enlarged intraabdominal or retroperitoneal nodes are usually malignant.)

Mediastinal lymphadenopathy is caused by primary lung diseases or systemic diseases with predilection for the mediastinal nodes.
Causes:

From Harrison's:

A more comprehensive list from the internet book of critical care:
Source

Infection Malignancy Interstitial lung disease Chronic medication
Tuberculosis (Usually asymmetric) Lymphoma Sarcoidosis (usually symmetric) Phenytoin
Non tuberculous mycobacteria Castleman disease Berylliosis Methotrexate
Fungi more frequent(histoplasmosis, Coccidioidomycosis) Kaposi sarcoma Silicosis Allopurinol
Fungi (less frequentt(Blastomycosis, cryptococcosis) CLL Coal workers pneumoconisis Aspirin
Atypical bacteria: Intrathoracic primary cancer Amyloidosis Erythromycin / sulfonamides / Penicillin
- Tularemia.
- Yersinia pestis (plague).
- Anthrax.
- Psittacosis.
- Coxiella burnetii (Q fever).
- Mycoplasma pneumoniae.
Mets from extrathoracic sites Mild lymphadenopathy (e.g., 1-1.5 cm) may be seen with various idiopathic interstitial lung diseases, including:

- Idiopathic pulmonary fibrosis.
- Connective tissue-related interstitial lung disease.
- Hypersensitivity pneumonitis.
- Organizing pneumonia.
- Chronic eosinophilic pneumonia.
Viral
- EBV (Epstein Barr virus).
- VZV (varicella zoster virus).
- Influenza H1N1.

Calcification of lymph nodes

Granulomatous diseases can cause calcification of lymph nodes.

Calcification is also seen in


Sarcoidosis

[!TIP] Summary
Symmetrical Bilateral Hilar lymphadenopathy (BHL) is a characteristic feature of sarcoidosis and is usually asymptomatic.

Sarcoidosis.png
#sarcoidosis

[!INFO] Lupus pernio
LupusPernioSarcoidosi.png

Lupus pernio = cutaneous sarcoidosis
Lupus vulgaris = cutaneous tuberculosis

Heart can also be involved: Mild to life threatening spectrum.

Clinical features:

SarcoidosisStages.png

[!INFO] Löfgren’s syndrome:
Lofgren's syndrome is an acute form of the sarcoidosis characterised by

[!INFO] Heerfordt's syndrome
Heerfordt's syndrome
A rare subacute form of [[Sarcoidosis]]
HeerfordtsSyndrome.webp (uveoparotid fever) there is parotid enlargement, fever and uveitis secondary to sarcoidosis

Investigations

FBC: Leukopenia and eosinophilia + thrombocytopenia (rare) and Mild NCNC anaemia.
CXR: Bilateral Hilar lymphadenopahty - very common!
Hypercalcemia secondary to increased vitamin D production (macrophages activate a vitamin D precursor)
Renal involvement with elevated creatinine is uncommon

Prognosis

Management

Causes of bilateral hilar lymphadenopathy

[!TIP] Bilateral Hilar lymphadenopathy SCaLP
Causes of bilateral Hilar lymphadenopathy

  1. Lymphoma,
  2. pulmonary TB,
  3. carcinoma of the bronchus,
  4. sarcoidosis
    #hilar-Lymphadenopathy #mediastinal-Lymphadenopathy

Differential diagnosis of hilar lymphadenopathy

Clinical context: "non superficial lymph nodes".
(In contrast, enlarged intraabdominal or retroperitoneal nodes are usually malignant.)

Mediastinal lymphadenopathy is caused by primary lung diseases or systemic diseases with predilection for the mediastinal nodes.
Causes:

From Harrison's:

A more comprehensive list from the internet book of critical care:
Source

Infection Malignancy Interstitial lung disease Chronic medication
Tuberculosis (Usually asymmetric) Lymphoma Sarcoidosis (usually symmetric) Phenytoin
Non tuberculous mycobacteria Castleman disease Berylliosis Methotrexate
Fungi more frequent(histoplasmosis, Coccidioidomycosis) Kaposi sarcoma Silicosis Allopurinol
Fungi (less frequentt(Blastomycosis, cryptococcosis) CLL Coal workers pneumoconisis Aspirin
Atypical bacteria: Intrathoracic primary cancer Amyloidosis Erythromycin / sulfonamides / Penicillin
- Tularemia.
- Yersinia pestis (plague).
- Anthrax.
- Psittacosis.
- Coxiella burnetii (Q fever).
- Mycoplasma pneumoniae.
Mets from extrathoracic sites Mild lymphadenopathy (e.g., 1-1.5 cm) may be seen with various idiopathic interstitial lung diseases, including:

- Idiopathic pulmonary fibrosis.
- Connective tissue-related interstitial lung disease.
- Hypersensitivity pneumonitis.
- Organizing pneumonia.
- Chronic eosinophilic pneumonia.
Viral
- EBV (Epstein Barr virus).
- VZV (varicella zoster virus).
- Influenza H1N1.

Calcification of lymph nodes

Granulomatous diseases can cause calcification of lymph nodes.

Calcification is also seen in


AlportSyndromeCreativeMeddoses.jpg


" MesPGN may occur in several renal diseases such as IgA nephropathy (commonly), IgM nephropathy, lupus nephritis, and C1q nephropathy". Source


one and a half syndrome

OneAndAHalfOAHSyndrome.jpg

(A) Pathologic lesion (oval shaded area) in the dorsal pontine tegmentum involves both ipsilateral PPRF (or the abducens nucleus) and the ipsilateral MLF; (B) Position of eyeballs, with rightward gaze, the left eye has the impaired adduction, while the abduction of the right eye is intact, except for the nystagmus, and with left gaze, both eyes have impaired horizontal movement (abduction of the left eye and adduction of right eye).

Source